MBBS (Hons I), FRACP, Director, Department of Medicine, Toowoomba Hospital, Qld; Academic Discipline Lead, Medical Specialties, School of Medicine, Rural Clinical School, University of Queensland, Qld.
MBBS, BMedSc, FRACS, FAOrthA, Deputy Director, Department of Orthopaedics, Toowoomba Hospital, Qld; Senior Lecturer, School of Medicine, Rural Clinical School, University of Queensland, Qld.
Aust J Gen Pract. 2021 Jan-Feb;50(1-2):23-29. doi: 10.31128/AJGP-10-20-5690.
Paget's disease of bone (PDB) is a common destructive condition of bone that affects 1-2% of the population, most typically those over the age of 55 years. It is usually asymptomatic.
The aim of this article is to describe the clinical presentation, diagnosis and management of patients with PDB.
Most cases of PDB are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Symptomatic patients present with bone pain, fractures, arthritis and features of compression neuropathy. Diagnosis is made on the basis of typical radiological features on plain films, while a radionuclide bone scan may be used to assess the extent of disease. The mainstay of treatment for PDB is bisphosphonate therapy, with zoledronic acid being the most effective agent. A single infusion of zoledronic acid leads to a sustained reduction in bone pain and markers of bone turnover. However, bisphosphonates should be reserved for symptomatic patients, as treatment with these agents has been associated with an increase in rates of fracture in patients with asymptomatic PDB.
佩吉特病（PDB）是一种常见的骨骼破坏性疾病，影响人群的 1%-2%，大多数患者年龄超过 55 岁。该病通常无症状。
本文旨在描述 PDB 患者的临床表现、诊断和治疗。
大多数 PDB 病例是在 X 光片上偶然发现的，或者是血清碱性磷酸酶的孤立升高。有症状的患者表现为骨痛、骨折、关节炎和压迫性神经病的特征。诊断基于平片上的典型影像学特征，而放射性核素骨扫描可用于评估疾病的范围。PDB 的主要治疗方法是双膦酸盐治疗，唑来膦酸是最有效的药物。唑来膦酸单次输注可导致骨痛和骨转换标志物的持续减少。然而，双膦酸盐应保留给有症状的患者，因为这些药物的治疗与无症状 PDB 患者骨折发生率的增加有关。
